Expert Panel Urges Clinicians to Get Involved With Public Health Issues

In addition to the ongoing COVID-19 pandemic, significant public health concerns include opioid overdoses, maternal mortality disparities, and climate change.

In the opening session at the American Heart Association 2022 Scientific Sessions, a panel of experts discussed how clinicians in multiple disciplines can get involved with public health issues, such as hypertension, maternal mortality, and climate change.

The COVID-19 pandemic continues to be top of mind, and former Surgeon General Jerome Adams, MD, discussed his experiences in that role from 2017 to 2021. COVID-19 will probably prove to be one of the biggest risk factors for cardiovascular negative outcomes, Adams said, and all clinicians must urge patients to stay up to date with their booster vaccines. Importantly, Adams noted that the same patients at risk for cardiovascular, kidney disease, and other issues are those who are under-boosted.

Adams also tackled the opioid epidemic, maternal mortality, and hypertension during his tenure as surgeon general. To address the growing number of deaths from opioid overdose, Adams said he urged all clinicians to carry naloxone and to encourage patients to do the same. He pointed to the teaching of CPR as an example, saying that CPR saves lives the same way that naloxone can.

“Most overdose deaths are witnessed, but they are not administered naloxone,” Adams said, adding that there are significant disparities around education and availability of naloxone in communities of color.

Adams also highlighted maternal mortality in the United States, calling it the “biggest and clearest example of structural racism.” Most other disparities tend to improve when controlling for education and income levels, but Adams said this is not true for maternal mortality. For instance, a Black woman in the United States with a PhD is still significantly more likely to die during childbirth than a white woman with no high school degree, Adams said.

“We’ve got to be willing to confront the fact that our systems are not set up to help those most in need and those who are more likely to suffer from negative outcomes,” Adams said.

Regina Benjamin, MD, MBA, 18th United States Surgeon General, agreed with Adams and added that many of the disparities in communities of color are also seen in rural areas. Benjamin also emphasized the impacts of climate change on public health, pulling from her experiences in Alabama after Hurricane Katrina. Climate change has a myriad of impacts, including on health, economic issues, lifestyle and social impacts, mental health, cancer, and allergens.

From a cardiovascular perspective, Benjamin noted that core body temperature is known to affect heart rate and breathing.

“We have to describe climate health in a way that people really understand,” Benjamin said. “It’s been so politicized for so many reasons, and some of those are really meant to discourage us and discount climate change.”

Benjamin operates a clinic in Alabama that was significantly affected by Hurricane Katrina. Although that experience was challenging, Benjamin said she believes the issues with climate change are getting worse. She pointed to the ice storms in Texas and the Mississippi River drought as examples and noted that all of these compounding issues cause significant stress.

To handle these issues in health care, Benjamin said it is essential to build resilient communities and individuals by continuing to advocate for their health. One potential way to advocate in these issues is by getting involved with robust air quality and water standards.

“It’s not just about disasters,” Benjamin said. “It’s about how we live between those disasters.”

Finally, Fausto Pinto, MD, PhD, former president of the World Health Federation and past president of the European Society of Cardiology, provided a global perspective for the discussion. Pinto said there is a global need to prepare future clinicians and prepare them to address unmet needs and disparities in cardiovascular care. He noted that there is a very important role for scientific societies and other organizations to get provide guidance on the training.

“I feel that we all have that responsibility, and it’s by working together and also providing the solutions and identifying needs [that we can do that],” Pinto said. “It’s our duty to find the best solutions, or at least try to find the best solutions and implement those.”

REFERENCE

Adams J, Albert M, Benjamin R, Califf R, Patel M. Moving Science into Public Health: Lessons Learned. Presented at American Heart Association 2022 Scientific Sessions. November 5, 2022.